Medical/health care providers (“care providers”) are increasingly being put under pressure to improve their outcomes and decrease costs. Outpatient services are one way to decrease costs by not requiring patients to utilize hospitals. Whether patients are discharged from hospitals or outpatient services, means of reducing re-admissions are desirable to reduce costs, and in fact, government agencies and insurance companies are putting pressure on care providers to avoid costly re-admissions. Finally, patient home care is increasingly being utilized to avoid nursing home costs and risks (such as risk of transmitting communicable infections).
To support all of these services in a reduced-cost matter, such care providers are increasingly bringing services to the homes of the patients. Follow up care is utilized to help prevent costly readmissions, and to ensure that the patients are complying with doctor ordered drug and therapy regimes. Furthermore, nurses, skilled therapists, and other service providers are visiting the homes of the patients to provide such services. Such providers of services can often thereby visit the homes of patients to provide their services.
However, a problem exists that currently, it is difficult to ensure that these providers are performing the services for which they are being paid. Visits are typically self-reported by the provider employee, and thus can easily be improperly reported or even fraudulently misrepresented. Currently, provider activities done in patient homes use paper systems utilizing a “time sheet” that is filled out manually by the provider employee and then signed by both the Provider employee and the patient (client) and then forwarded to a third party for processing. However, such time sheets are basically validated by an “honor system” that accepts the word of the provider employee and client. The client does not typically work as an effective check or verification on this process, as there is rarely much motivation on the client to check the actual time entries of the provider employee, because the client is typically not paying directly for the services and in some cases may not be mentally capable of checking the employee's entries.
Hence, payer organizations desire proof and more effective verifications that such provider employees are actually providing the services for which the provider is billing the payer. Hence, a means of better ensuring that the services being billed have actually been performed is desirable.